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[Rosepetal73]

Could someone explain to me why oestrogen only HRT doesn't cause an increase in breast cancer?  I thought oestrogen promoted growth and progesterone put the brakes on.  Is it the synthetic progesterons that are the issue in combined HRT?  Are there any studies on the newer estrogel and micronised progesterone? All the studies are so old (and scary)!

[Ladybt28]

I can't explain the technical medical stuff properly.. possibly Connolly or Hurdity would do a better job with that.  All I can say is there are new studies recently published in the last 2 years which have totally disproved the previous "scary" stuff.

Somewhere on the forum - recently in the last 2 months there is a thread with a video link which shows Dr Louise Newsom (this is a written piece from her below - sorry if my links are not in the right place I'm not very good the that bit of the forum) https://www.menopausedoctor.co.uk/menopause/breast-cancer-hrt (I think the answers to your questions are in that piece)
and a specialist cancer dr talking as part of a forum about this very subject and there was also a television program recently that talked about it and put up on a big screen the risks associated with the different part of hrt.
Anyway the long and the short of it was that the risk is now considered very low and those women who get breast cancer on hrt are likely to have been predisposed to get breast cancer whether they took it or not.  It has been proven that hrt helps prevent osteoperosis in women who start taking it in peri and contrary to increasing strokes (unless there is some other underlying issue) it helps with heart health. However, a lot of GPs' and some consultants are not as up to date with the latest medical data as they should be.

[Rosepetal73]

Shameless bump....

Anyone?

[Ladybt28]

"shameless bump..
anyone"

Sorry Rosepetal??

[Rosepetal73]

Shameless bump means replying to your own thread so it goes to the top of the posts.  It's a bit frowned upon on most forums

And ‘anyone?' - I'm looking for some assistance with my medical /technical questions.  I have scoured the internet and can't find anything but ladybt28 I do quite like Dr Louise Newsom's advice.  My attitude to breast cancer isn't as balanced as most - I found a lump (a benign, post-pregnancy thing) when I had PND and it scared the life out of me so taking HRT seems counter-intuitive despite understanding the statistics (and their limits) and the upsides to other areas of health - bones, heart etc.

[Conolly]

Hello Rosepetal73,

There's no definitive answer to why ERT doesn't cause an increase in breast cancer, there are not enough long term studies and clinical trials to strongly support this evidence, some studies show a slight increase while others show a slight decrease, so the subject is still under scrutiny.

Oestrogen and progesterone have different roles depending on the target cell type. Their action on breast cells depends on the presence of hormonal receptors (both for oestrogen and progesterone), and that can vary widely amongst women. Most studies show the progestogen in combined HRT has been associated with increased BC risk, but the subject is also still under scrutiny.

Regarding estradiol gel and micronised progesterone, I'm not aware of clinical trials or long term studies. The ones available are primarily observational. Micronised progesterone has been studied primarily for gestation purpose.

That's why leaflets of HRT products still state the same warnings, despite menopause medical societies all around the world advocate the change of product labeling for low dose vaginal oestrogen.

Conolly X

[Rosepetal73]

Thank you Conolly.  It appears the answers I'm looking for aren't available atm.  Those two studies in the early 2000's have done so much damage and it appears there are so many flaws in the studies.  It really isn't very nice to scare 50% of the population to death 

[Hurdity]

Hi there

There is the KEEPS trial which looked at smaller numbers of women on estradiol and progesterone for five years. Hereis a summary of the main findings https://thebms.org.uk/2012/10/keeps-trial-results/ - but there are more detailed studies elsewhere.

There is a recent review paper also which looks at the effect of different progestogens on breast cancer risk:
https://www.tandfonline.com/doi/pdf/10.1080/13697137.2017.1421925?needAccess=true

It's a pdf so format comes out weird!

ABSTRACT
Postmenopausal women with an intact uterus using estrogen therapy should receive a progestogen
for endometrial protection. The debate on bioidentical hormones including micronized progesterone
has increased in recent years. Based on a systematic literature review on the impact of menopausal
hormone therapy (MHT) containing micronized progesterone on the mammary gland, an international
expert panel
'
s recommendations are as follows: (1) estrogens combined with oral (approved) or vaginal
(off-label use) micronized progesterone do not increase breast cancer risk for up to 5 years of treat-
ment duration; (2) there is limited evidence that estrogens combined with oral micronized progester-
one applied for more than 5 years are associated with an increased breast cancer risk; and (3)
counseling on combined MHT should cover breast cancer risk
–
regardless of the progestogen chosen.
Yet, women should also be counseled on other modifiable and non-modifiable breast cancer risk fac-
tors in order to balance the impact of combined MHT on the breast.

The oestrogen risk found in the WHI study as far as I understand is that many of the women will already have had undiagnosed breast cancer - and it is accepted that many breast cancers are oestrogen positive and therefore if you develop it, then these types of cancer could grow quite quickly with oestrogen than without oestrogen.

It's a very complex subject and not fully understood yet.

Hurdity x

[Emerald2017]

Hi! I think that the risk factor is about the number of the cycles we have and not just the estrogen. With each cycle we have, our tissue at breast proliferates before we get our period and resolves when we have it. Proliferating cells are designed to stop proliferation when our period starts. And a cancer cell is simply a cell that proliferates without control. So with each cycle we simply have more risks a normal proliferating cell to become a cancer cell.
In addition different kinds of progestins have different risk profile and influence on the breast.
That is why a late menopause is related with an increased risk for breast cancer.
Estrogen is considered safer but not completely safe.